Skip to main content
SpringerLink
Log in

Which is the best laparoscopic approach for inguinal hernia repair: TEP or TAPP? A systematic review of the literature with a network meta-analysis

  • Review
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Totally extraperitoneal (TEP) repair and transabdominal preperitoneal (TAPP) repair are the most used laparoscopic techniques for inguinal hernia treatment. However, many studies have shown that laparoscopic hernia repair compared with open hernia repair (OHR) may offer less pain and shorter convalescence. Few studies compared the clinical efficacy between TEP and TAPP technique. The purpose of this study is to provide a comparison between TEP and TAPP for inguinal hernia repair to show the best approach.

Methods

We performed an indirect comparison between TEP and TAPP techniques by considering only randomized, controlled trials comparing TEP with OHR and TAPP with OHR in a network meta-analysis. We considered the following outcomes: operative time, postoperative complications, hospital stay, postoperative pain, time to return to work, and recurrences.

Results

The two techniques improved some short outcomes (such as time to return to work) with respect to OHR. In the network meta-analysis, TEP and TAPP were equivalent for operative time, postoperative complications, postoperative pain, time to return to work, and recurrences, whereas TAPP was associated with a slightly longer hospital stay compared with TEP.

Conclusions

TEP and TAPP improved clinical outcomes compared with OHR, but the network meta-analysis showed that TEP and TAPP efficacy is equivalent. TAPP was associated with a slightly longer hospital stay compared with TEP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13

Similar content being viewed by others

References

  1. Testini M, Lissidini G, Poli E, Gurrado A, Lardo D, Piccinni G (2010) A single-surgeon randomized trial comparing sutures, N-butyl-2-cyanoacrylate and human fibrin glue for mesh fixation during primary inguinal hernia repair. Can J Surg 53:155–160

    PubMed  Google Scholar 

  2. Vatansever U, Acunas B, Demir M, Karasalihoglu S, Ekuklu G, Ener S, Pala O (2002) Nucleated red blood cell counts and erythropoietin levels in high-risk neonates. Pediatr Int 44:590–595

    Article  PubMed  CAS  Google Scholar 

  3. Tolver MA, Strandfelt P, Rosenberg J, Bisgaard T (2011) Pain characteristics after laparoscopic inguinal hernia repair. Surg Endosc 25:3859–3864

    Article  PubMed  Google Scholar 

  4. Schmedt CG, Sauerland S, Bittner R (2005) Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc 19:188–199

    Article  PubMed  CAS  Google Scholar 

  5. Wake BL, McCormack K, Fraser C, Vale L, Perez J, Grant AM (2005) Transabdominal pre-peritoneal (TAPP) vs totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair. Cochrane Database Syst Rev 1:CD004703

  6. Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13:343–403

    Article  PubMed  CAS  Google Scholar 

  7. Lumley T (2002) Network meta-analysis for indirect treatment comparisons. Stat Med 21:2313–2324

    Article  PubMed  Google Scholar 

  8. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Br Med J 339:b2535

    Article  Google Scholar 

  9. Jansen JP, Fleurence R, Devine B, Itzler R, Barrett A, Hawkins N, Lee K, Boersma C, Annemans L, Cappelleri JC (2011) Interpreting indirect treatment comparisons and network meta-analysis for health-care decision making: report of the ISPOR Task Force on Indirect Treatment Comparisons Good Research Practices. Part 1. Value Health 14:417–428

    Article  PubMed  Google Scholar 

  10. Sutton A, Abrams K, Jones D, Sheldon T, Song F (2000) Methods for meta-analysis in medical research. Wiley, Chichester

    Google Scholar 

  11. Wallace BC, Schmid CH, Lau J, Trikalinos TA (2009) Meta-analyst: software for meta-analysis of binary, continuous and diagnostic data. BMC Med Res Methodol 9:80

    Article  PubMed  Google Scholar 

  12. Bucher HC, Guyatt GH, Griffith LE, Walter SD (1997) The results of direct and indirect treatment comparisons in meta-analysis of randomized controlled trials. J Clin Epidemiol 50:683–691

    Article  PubMed  CAS  Google Scholar 

  13. Kouhia ST, Huttunen R, Silvasti SO, Heiskanen JT, Ahtola H, Uotila-Nieminen M, Kiviniemi VV, Hakala T (2009) Lichtenstein hernioplasty versus totally extraperitoneal laparoscopic hernioplasty in treatment of recurrent inguinal hernia: a prospective randomized trial. Ann Surg 249:384–387

    Article  PubMed  Google Scholar 

  14. Eklund A, Rudberg C, Smedberg S, Enander LK, Leijonmarck CE, Osterberg J, Montgomery A (2006) Short-term results of a randomized clinical trial comparing Lichtenstein open repair with totally extraperitoneal laparoscopic inguinal hernia repair. Br J Surg 93:1060–1068

    Article  PubMed  CAS  Google Scholar 

  15. Eklund AS, Montgomery AK, Rasmussen IC, Sandbue RP, Bergkvist LA, Rudberg CR (2009) Low recurrence rate after laparoscopic (TEP) and open (Lichtenstein) inguinal hernia repair: a randomized, multicenter trial with 5-year follow-up. Ann Surg 249:33–38

    Article  PubMed  Google Scholar 

  16. Gokalp A, Inal M, Maralcan G, Baskonus I (2003) A prospective randomized study of Lichtenstein open tension-free versus laparoscopic totally extraperitoneal techniques for inguinal hernia repair. Acta Chir Belg 103:502–506

    PubMed  CAS  Google Scholar 

  17. Colak T, Akca T, Kanik A, Aydin S (2003) Randomized clinical trial comparing laparoscopic totally extraperitoneal approach with open mesh repair in inguinal hernia. Surg Laparo Endo Per 13:191–195

    Article  Google Scholar 

  18. Andersson B, Hallen M, Leveau P, Bergenfelz A, Westerdahl J (2003) Laparoscopic extraperitoneal inguinal hernia repair versus open mesh repair: a prospective randomized controlled trial. Surgery 133:464–472

    Article  PubMed  Google Scholar 

  19. Pawanindra L, Kajla RK, Chander J, Saha R, Ramteke VK (2003) Randomized controlled study of laparoscopic total extraperitoneal versus open Lichtenstein inguinal hernia repair. Surg Endosc 17:850–856

    Article  Google Scholar 

  20. Suter M, Martinet O (2002) Postoperative pulmonary dysfunction after bilateral inguinal hernia repair: a prospective randomized study comparing the Stoppa procedure with laparoscopic total extraperitoneal repair (TEPP). Surg Laparosc Endosc Percutan Tech 12:420–425

    Article  PubMed  CAS  Google Scholar 

  21. Bringman S, Ramel S, Heikkinen TJ, Englund T, Westman B, Anderberg B (2003) Tension-free inguinal hernia repair: TEP versus mesh-plug versus Lichtenstein: a prospective randomized controlled trial. Ann Surg 237:142–147

    Article  PubMed  Google Scholar 

  22. Khoury N (1998) A randomized prospective controlled trial of laparoscopic extraperitoneal hernia repair and mesh-plug hernioplasty: a study of 315 cases. J Laparoendosc Adv Surg Technol A 8:367–372

    Article  CAS  Google Scholar 

  23. Hallen M, Bergenfelz A, Westerdahl J (2008) Laparoscopic extraperitoneal inguinal hernia repair versus open mesh repair: long-term follow-up of a randomized controlled trial. Surgery 143:313–317

    Article  PubMed  Google Scholar 

  24. Mahon D, Decadt B, Rhodes M (2003) Prospective randomized trial of laparoscopic (transabdominal preperitoneal) vs. open (mesh) repair for bilateral and recurrent inguinal hernia. Surg Endosc 17:1386–1390

    Article  PubMed  CAS  Google Scholar 

  25. Sarli L, Iusco DR, Sansebastiano G, Costi R (2001) Simultaneous repair of bilateral inguinal hernias: a prospective, randomized study of open, tension-free versus laparoscopic approach. Surg Laparosc Endosc Percutan Tech 11:262–267

    Article  PubMed  CAS  Google Scholar 

  26. Picchio M, Lombardi A, Zolovkins A, Mihelsons M, La Torre G (1999) Tension-free laparoscopic and open hernia repair: randomized controlled trial of early results. World J Surg 23:1004–1009

    Article  PubMed  CAS  Google Scholar 

  27. Beets GL, Dirksen CD, Go PM, Geisler FE, Baeten CG, Kootstra G (1999) Open or laparoscopic preperitoneal mesh repair for recurrent inguinal hernia? A randomized controlled trial. Surg Endosc 13:323–327

    Article  PubMed  CAS  Google Scholar 

  28. Heikkinen TJ, Haukipuro K, Hulkko A (1998) A cost and outcome comparison between laparoscopic and Lichtenstein hernia operations in a day-case unit. A randomized prospective study. Surg Endosc 12:1199–1203

    Article  PubMed  CAS  Google Scholar 

  29. Butters M, Redecke J, Koninger J (2007) Long-term results of a randomized clinical trial of Shouldice, Lichtenstein and transabdominal preperitoneal hernia repairs. Br J Surg 94:562–565

    Article  PubMed  CAS  Google Scholar 

  30. Douek M, Smith G, Oshowo A, Stoker DL, Wellwood JM (2003) Prospective randomised controlled trial of laparoscopic versus open inguinal hernia mesh repair: five-year follow-up. Br Med J 326:1012–1013

    Article  CAS  Google Scholar 

  31. Hamza Y, Gabr E, Hammadi H, Khalil R (2010) Four-arm randomized trial comparing laparoscopic and open hernia repairs. Int J Surg 8:25–28

    Article  PubMed  Google Scholar 

  32. Pokorny H, Klingler A, Schmid T, Fortelny R, Hollinsky C, Kawji R, Steiner E, Pernthaler H, Függer R, Scheyer M (2008) Recurrence and complications after laparoscopic versus open inguinal hernia repair: results of a prospective randomized multicenter trial. Hernia 12:385–389

    Article  PubMed  CAS  Google Scholar 

  33. Gunal O, Ozer S, Gurleyik E, Bahcebasi T (2007) Does the approach to the groin make a difference in hernia repair? Hernia 11:429–434

    Article  PubMed  CAS  Google Scholar 

  34. Dedemadi G, Sgourakis G, Karaliotas C, Christofides T, Kouraklis G (2006) Comparison of laparoscopic and open tension-free repair of recurrent inguinal hernias: a prospective randomized study. Surg Endosc 20:1099–1104

    Article  PubMed  CAS  Google Scholar 

  35. Heikkinen T, Bringman S, Ohtonen P, Kunelius P, Haukipuro K, Hulkko A (2004) Five-year outcome of laparoscopic and Lichtenstein hernioplasties. Surg Endosc 18:518–522

    Article  PubMed  CAS  Google Scholar 

  36. Bringman S, Blomqvist P (2005) Intestinal obstruction after inguinal and femoral hernia repair: a study of 33,275 operations during 1992–2000 in Sweden. Hernia 9:178–183

    Article  PubMed  CAS  Google Scholar 

  37. Song F, Loke YK, Walsh T, Glenny AM, Eastwood AJ, Altman DG (2009) Methodological problems in the use of indirect comparisons for evaluating healthcare interventions: survey of published systematic reviews. Br Med J 338:b1147

    Article  Google Scholar 

Download references

Disclosures

The authors have no conflict of interest to declare. This study was funded with structural funds of the authors’ institutions, which are public institutions.

Author information

Authors and Affiliations

  1. General and Mini-Invasive Surgical Unit, San Camillo Hospital, Trento, Italy

    Umberto Bracale & Giusto Pignata

  2. Department of General Vascular and Thoracic Surgery, University of Naples “Federico II”, Naples, Italy

    Umberto Bracale, Enrico Di Salvo & Giovanni Merola

  3. Department of Biomedical, Electronic and Telecommunication Engineering, University of Naples “Federico II”, Naples, Italy

    Paolo Melillo, Marcella Rovani & Leandro Pecchia

  4. Department of Electronics, Computer Science and Systems, University of Bologna, Bologna, Italy

    Paolo Melillo

  5. Electrical Systems and Optics Research Division, Faculty of Engineering, University of Nottingham, Nottingham, UK

    Leandro Pecchia

Authors
  1. Umberto Bracale
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paolo Melillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giusto Pignata
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Enrico Di Salvo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marcella Rovani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Giovanni Merola
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Leandro Pecchia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Umberto Bracale.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bracale, U., Melillo, P., Pignata, G. et al. Which is the best laparoscopic approach for inguinal hernia repair: TEP or TAPP? A systematic review of the literature with a network meta-analysis. Surg Endosc 26, 3355–3366 (2012). https://doi.org/10.1007/s00464-012-2382-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-012-2382-5

Keywords

Search

Navigation